Heart Failure Flashcards
give 8 causes of HF
- ischaemic heart disease (most common
- HTN
- valvular heart disease
- AF
- chronic lung disease
- cardiomyopathy
- previous cancer chemo drugs
- HIV
what are the 2 broad categories of HF
- HFrEF: less than 50%
- HFpEF: greater than 50%, diastolic dysfunction where there is an issue with the LV filling with blood during diastole
ejection fraction: % of blood in the LV squeezed out with each ventricular contraction
what are the key symptoms of HF
- Breathlessness, worsened by exertion
- Cough, which may produce frothy white/pink sputum
- Orthopnoea, which is breathlessness when lying flat, relieved by sitting or standing (ask how many pillows they use)
- PND
- Peripheral oedema
- Fatigue
what signs may you find O/E of a patient with HF
- Tachycardia
- Tachypnoea
- Hypertension
- Murmurs on auscultation indicating valvular heart disease
- 3rd heart sound on auscultation
- Bilateral basal crackles (sounding “wet”) indicating pulmonary oedema
- Raised JVP
- Peripheral oedema of the ankles, legs and sacrum
what are 3 possible mechanisms of PND
- fluid settles across large SA of lungs as pt lies flat to sleep causing dyspnoea. as they stand up, the fluid sinks back to the lung cases and upper lung areas can function more effectively
- resp centre in brain becomes less responsive during sleep so RR and effort do not inc in response to dec o2 sats - develops more significant p.congestion and hypoxia
- dec adrenaline circulating during sleep = more relaxed myocardium = dec CO
what is BNP
hormone released from the heart ventricles when the myocardium is stretched beyond the normal range
- raised BNP blood result indicates the heart is overloaded beyond its normal capacity to pump effectively
what is the action of BNP
- relaxes smooth muscle in blood vessels which reduces systemic vascular resistance making it easier for blood to pump through the system
- acts on kidneys as a diuretic to promote water excretion in the urine which reduces the circulating volume, helping to improve the function of the heart in someone that is fluid-overloaded
describe the specificity/sensitivity of BNP
sensitive but not specific meaning when it is negative it rules out HF but can be positive due to other reasons e.g:
- tachycardia
- sepsis
- PE
- renal impairment
- COPD
what are appropriate blood tests to investigate HF and explain their use
- U&Es: baseline renal function and diuretic effect
- FBC: anaemia as consequence of bone marrow issue
- LFTs: hepatic congestion
- TFT: thyroid disease
- ferritin/transferrin: younger pt w HH
- BNP
what are appropriate radiological investigations into HF and explain their use
- CXR
- ECHO/MRI: assess LV function and structural abnormalities
what are CXR findings of HF
what causes upper lobe diversion in HF
- usually when standing erect, lower lobe veins contain more blood and upper lobe veins remain small
- in acute LVF, there is back-pressure such that the upper lobe veins fill with blood and become engorged - upper lobe diversion
- this is visible as increased prominence and diameter of the upper lobe vessels on CXR
what additional x-ray findings does fluid leaking from oedeamtous lung tissue in HF cause
- bilateral pleural effusions
- fluid in interlobar fissures
- fluid in septal lines - Kerley B lines
what are possible findings on echo of LV in HF
- dilated poorly contracting LV (systolic dysfunction)
- stiff, poorly relaxing, small diameter LV (diastolic dysfunction)
- valvular heart diseasea
- atrial myxoma
- pericardial disease
what is the use of cardiac MRI in assessment of HF
- may elaborate cause for HF as the echo may miss the RV
- scar estimation + coronary disease assessment for viability of cardiac muscle